Dissociative Disorders Glossary

abreaction The discharge of energy [emotion] involved in recalling an event that has been repressed because it was consciously intolerable. The experience may be one of reliving the trauma as if it were happening in the present, complete with physical as well as emotional manifestations (also called revivification).

acting out Originally an analytic term referring to the expression of unconscious feelings about the analyst, the commonly used meaning is the expression of unconscious feelings or conflicts in actions rather than words. This can take many forms including dangerous behavior such as self-harm or suicidal gestures.

acute stress disorder A disorder first named in DSM-IV. It is similar to Post-Traumatic Stress Disorder (PTSD) in that it is evoked by the same types of stressors that precipitate PTSD. However, in this disorder, the symptoms occur during or immediately following the trauma. The primary criteria are the same as those for PTSD, except that the disturbance lasts for a minimum of three days and a maximum of four weeks and occurs within four weeks of the traumatic event. Adapted DSM-5

adjunctive therapies In addition to individual psychotherapy with a primary therapist, a client may receive other therapy such as art therapy, psychodrama, dance therapy, or assertiveness training. These are considered adjunctive therapies.

affect “A pattern of observable behaviors that is the expression of a subjectively experienced feeling state (emotion). Common examples of affect are sadness, elation, and anger. In contrast to mood, which refers to a more pervasive and sustained emotional `climate,’ affect refers to more fluctuating changes in emotional `weather.'” DSM-IV, p. 763.

alexithymia The inability to recognize or describe what one feels. This is common in post-traumatic stress disorder, somatization, and conversion disorders.

alter Another term for personality, alternate personality or personality state; also called an identity or dissociated part. A distinct identity or personality state, with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self. Modified from DSM-5 “Alters are dissociated parts of the mind that the patient experiences as separate from each other.” ISSD Practice Guidelines Glossary, 1994.

amnesia “Pathologic loss of memory; a phenomenon in which an area of experience becomes inaccessible to `conscious’ recall. The loss in memory may be organic, emotional, dissociative, or of mixed origin, and may be permanent or limited to a sharply circumscribed period of time.” American Psychiatric Glossary, p. 13. See also dissociative amnesia.

anniversary reaction The experience of reacting with feelings or behavior on the “anniversary” of a previous event. For example, an individual whose house burned down on September 22nd may for years after the event have intense feelings or reactions on or around September 22nd. In some cases the person may not even consciously recall why he or she is feeling differently on that date. A common anniversary reaction is temporary depression.

assertiveness training This is a cognitive/behavioral technique that teaches clients to express their feelings and needs rather than being passive and letting other people take advantage, overwhelm, or dominate them (a characteristic of people who were abused in childhood). After a client and therapist identify problem situations, the client practices appropriate confrontation. Assertiveness, a middle ground between being passive and aggressive/hostile, may be learned on a one-to-one basis or in a group.

attachment (bonding) The process of developing and maintaining a healthy relationship between people; healthy attachment between a parent and child, is characterized by a sense of security, emotional attunement and regulation of physiological functioning such that the developing child becomes able to self-regulate over time.

autonomic arousal A physical symptom of PTSD which occurs automatically when a person perceives a situation to be life-threatening. Also known as nervous system hyper-reactivity, this physical response bypasses the cognitive/thinking process and generally includes an elevated heart rate, dilation of pupils, perspiring, and other fear responses. Trauma survivors may re-experience autonomic arousal when remembering traumatic events. See also flight or fight response.

behavioral memory A lay term for implicit (or habit) memory. This type of memory is encoded in terms of a pattern of behavior rather than explicit knowledge. This term often refers to actions or fears which may indicate unconfirmed memories. (Lenore Terr, M.D., personal correspondence, 31 August 1994).

body memory This popularly-used term is actually a misnomer. The body does not have neurons capable of remembering; only the brain does. The term refers to body sensations that symbolically or literally captures some aspect of the trauma. Sensory impulses are recorded in the parietal lobes of the brain, and these remembrances of bodily sensations can be felt when similar occurrences or cues restimulate the stored memories.(Lenore Terr, M.D., personal correspondence, 31 August 1994). For example, a person who was raped may later experience pelvic pain similar to that experienced at the time of the event. This type of bodily sensation may occur in any sensory mode: tactile, taste, smell, kinesthetic, or sight. Body memories may be diagnosed as somatoform disorder. See also somatic memory.

borderline personality disorder (BPD) Borderline personality disorder is best understood as an attachment disorder. It is indicated by a pattern of instability in personal relationships, emotional response, self-image and impulsivity. A person with borderline personality disorder may go to great lengths to avoid abandonment (real or perceived), have recurrent suicidal behavior, display inappropriate intense anger or have chronic feelings of emptiness. To diagnose borderline personality disorder, the following criteria must be met:

A. Significant impairments in personality functioning manifest by both:

1. Impairments in self functioning (a or b):
   • a. Identity: Markedly impoverished, poorly developed, or unstable self-image, often associated with excessive selfcriticism; chronic feelings of emptiness; dissociative states under stress.
   • b. Self-direction: Instability in goals, aspirations, values, or career plans.
2. Impairments in interpersonal functioning (a or b):
   • a. Empathy: Compromised ability to recognize the feelings and needs of others associated with interpersonal hypersensitivity (i.e., prone to feel slighted or insulted); perceptions of others selectively biased toward negative attributes or vulnerabilities.
   • b. Intimacy: Intense, unstable, and conflicted close relationships, marked by mistrust, neediness, and anxious preoccupation with real or imagined abandonment; close relationships often viewed in extremes of idealization and devaluation and alternating between over involvement and withdrawal.

B. Pathological personality traits in the following domains:

1. Negative Affectivity, characterized by:
   • a. Emotional liability: Unstable emotional experiences and frequent mood changes; emotions that are easily aroused, intense, and/or out of proportion to events and circumstances.
   • b. Anxiousness: Intense feelings of nervousness, tenseness, or panic, often in reaction to interpersonal stresses; worry about the negative effects of past unpleasant experiences and future negative possibilities; feeling fearful, apprehensive, or threatened by uncertainty; fears of falling apart or losing control.
   • c. Separation insecurity: Fears of rejection by – and/or
     separation from – significant others, associated with fears of excessive dependency and complete loss of autonomy.
   • d. Depressivity: Frequent feelings of being down, miserable, and/or hopeless; difficulty recovering from such moods; pessimism about the future; pervasive shame; feeling of inferior self-worth; thoughts of suicide and suicidal behavior.
2. Disinhibition, characterized by:
   • a. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing or following plans; a sense of urgency and self-harming behavior under emotional distress.
   • b. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard to consequences; lack of concern for one’s limitations and denial of the reality of personal danger.
3. Antagonism, characterized by:
   • a. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults.

C. The impairments in personality functioning and the individual’s personality trait expression are relatively stable across time and consistent across situations, are not better understood as normative for the individual’s developmental stage or socio-cultural environment, and are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma) (adapted by the DSM-5)

boundaries For the comfort and safety of the client, therapist, and other outsiders, behavioral boundaries often need to be established. These limits may affect a range of issues from details of personal and therapeutic interactions, such as length of therapy sessions; appropriate touching; number, and duration, of phone calls to prevention of assault and suicide. Setting boundaries is particularly important in the treatment of dissociative disorders since lack of boundaries is usually a part of the history of a person who has been abused.

brief psychotic disorder a recurrent, transient thought disorder, which typically occurs in adolescence or young adulthood. By definition, it is of short duration, although it can result in increased risk of suicidality, or inability to perform self-care (American Psychiatric Association, 2013). The DSM- 5 criteria are:

• The presence of one or more psychotic symptoms
• The episode lasts at least one day but less than one month with eventual return to previous functioning
• The disturbance is not better accounted for by another mental illness and is not due to the physiological effects of a substance or general medical condition.

For this condition there are specifiers that can be used to further describe the disorder: with marked stressor(s), without marked stressor(s), and with postpartum onset. Adapted from DSM-5

co-consciousness For a person with DID (MPD), this is the awareness of the thoughts, feelings, beliefs, needs, etc. of other personality states.

co-existing disorders Refers to cases in which an individual has more than one mental disorder as described in the DSM-5. Also known as co- morbidity. See also dual diagnosis.

cognitive/behavioral treatment A treatment approach that focuses both on observable behavior and on the thinking or beliefs that accompany the behavior. In psychotherapy, dysfunctional or maladaptive behaviors, thoughts, and beliefs are replaced by more adaptive ones. This approach is increasingly being used in the treatment of DID (MPD) and BPD.

cognitive distortion An error in thinking or reasoning based on drawing incorrect conclusions about past experience. For example, a trauma survivor who was sexually abused by a man with a beard might overgeneralize from the trauma experience and conclude that all men with beards are dangerous.

cognitive therapy A form of therapy that focuses on what the client thinks or believes. In this model, faulty thinking is seen as the basis for negative emotions and maladaptive behavior. Therapeutic intervention helps clients explore erroneous thoughts and beliefs and replace them with a more realistic assessment of themselves and their situation.

complex PTSD (C-PTSD)- a condition that results from chronic, repetitive exposure to trauma in which the victim has no hope for escape, such as in cases of long term child abuse, domestic violence, or slavery and trafficking. Complex PTSD is not identified as a separate diagnosis of PTSD in the DSM-5, but it will be included in the 11th revision of the International Classification of Diseases (ICD-11). It was first described by Judith Herman in her book Trauma and Recovery, 1992. Complex PTSD is very common in people with dissociative identity disorder. See also Posttraumatic Stress Disorder.

confabulation This term originally referred to a neurological deficit in which a person who is unable to recall previous situations or events fabricates stories in response to questions about those situations or events. It is used more broadly to refer to “false memories” that are supposedly created in response to questions asked by a therapist or interviewer.

containment The process of consciously postponing dealing with intrusive PTSD symptoms, being able to notice a symptom, communicate about it, set it aside (contain it), and revisit it later.

context dependent memory See state dependent memory.

contracts Verbal or written agreements made between therapist and client for the express purposes of setting safe and reasonable boundaries for the client, to nurture the client’s sense of cause and effect, and to encourage the internal personality system to take responsibility for its behavior.

conversion disorder A condition in which a person has neurological symptoms that cannot be explained by medical evaluation. This disorder is a subset under the umbrella term, Functional Neurological Symptom Disorder, in the DSM-5. It is specified as conversation disorder if the symptoms are induced by a psychological stressor. Often precipitated by psychosocial stress, people with trauma histories have a higher than average rate of conversion disorder. The DSM-5 criteria are:

• One or more symptoms or deficits affecting voluntary motor or sensory function
• Clinical findings provide evidence of incompatibility between the symptom and recognized neurological or medical conditions
• The symptoms or deficits cause clinically significant distress or impairment in functioning or warrant medical evaluation
• The symptoms or deficits are not better accounted for by another medical or mental disorder Adapted from DSM-5

countertransference A therapist’s conscious or unconscious emotional reactions to a client. It is a therapist’s job to monitor his or her reactions to a client and to minimize their impact on the therapeutic relationship and treatment.

delayed memory This term is used to describe the experience of an individual who recalls a memory for which he or she was previously amnestic. The recollection may occur spontaneously or in the context of therapy.

depersonalization/derealization disorder One of the dissociative disorders described in DSM- 5. The criteria include:

• Persistent or recurrent experiences of depersonalization, derealization or both:
  Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one's thoughts, feelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
  Derealization: "Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted."
• During the depersonalization or deprealization experience, reality testing remains intact
• The depersonalization or derealization causes clinically significant distress or impairment in functioning
• The depersonalization or derealization experience is not attributable to another mental disorder, the effects of a substance, or a general medical condition.(Adapted from DSM-5)

These experiences can happen after a traumatic or other overwhelming experience, without meeting the criteria for a disorder. Depersonalization is often referred to as an "out of body" experience.

DES See Dissociative Experiences Scale.

Diagnostic and Statistical Manual of Mental Disorders The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013 by the American Psychiatric Association. It contains standard definitions of psychological disorders. The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM- IV) was published in 1994. DSM-III-R refers to the third edition, revised, of the same manual, published in 1987. The diagnostic categories referred to in the trauma literature published in the late 1980s and early 1990s are those from the DSM-III-R.

DID See dissociative identity disorder.

dissociation The separation of ideas, feelings, information, identity, or memories that would normally go together. Dissociation exists on a continuum: At one end are mild dissociative experiences common to most people (such as daydreaming or highway hypnosis) and at the other extreme is severe chronic dissociation, such as DID (MPD) and other dissociative disorders. Dissociation appears to be a normal process used to handle trauma that over time becomes reinforced and develops into maladaptive coping.

dissociative amnesia One of the dissociative disorders described in DSM-5. The four criteria are:

• An inability to recall important autobiographic information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. (Note: Dissociative Amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history.)
• The symptoms cause clinically significant distress or impairment in functioning.
• The disturbance is not attributable to the physiological effects of a substance (e.g., alcohol or other drug abuse, a medication) or a neurological or other medical condition (e.g., partial complex seizures, transient global amnesia, sequelae of a closed head injury/traumatic brain injury, other neurological condition).
• The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder.

dissociative disorder not otherwise specified (DDNOS) In the DSM-IV this was the diagnostic category for individuals who have dissociative symptoms but do not meet the minimum criteria for any of the specific dissociative disorders. A client who has some (but not all) DID symptoms, and who does not have amnesia for important personal information, would be an example of a person with DDNOS. DSM- IV, p. 590. In the DSM-5, this diagnostic category has been changed to other specified dissociative disorder (OSDD) or unspecified dissociative disorder.

dissociative disorders A group of psychiatric conditions with the disruption in the integrated functions of consciousness, memory, identity, or perception of the environment. DID (MPD) is one disorder in this category. See also dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization/derealization disorder, other specified dissociative disorder, and unspecified dissociative disorder.

Dissociative Experiences Scale (DES) Developed by Frank W. Putnam M.D. and Eve B. Carlson, Ph.D., the DES is a 28-item self-report instrument that can be completed in about 10 minutes. It asks the respondent to indicate the frequency with which certain dissociative or depersonalization experiences occur. An example of a typical DES question is “Some people have the experience of feeling that their body does not seem to belong to them. Circle a number to show what percentage of the time this happens to you.”

dissociative fugue A sudden, apparently purposeful, travel away from home, work, or significant others for an extended period of time (days or weeks), or with bewildered wandering. The amnesia is typically associated with confusion about one's identity, and presentation of a new identity may occur. This was previously a separate dissociative disorder diagnosis, but is combined with Dissociative Amnesia in the DSM-5.

dissociative identity disorder (DID) One of the dissociative disorders in DSM- 5. There are four five diagnostic criteria:

1. Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption of marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
2. Amnesia must occur inconsistent with ordinary forgetting, defined as gaps in the recall of everyday events, important personal information and/or traumatic events.
3. The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
4. The disturbance is not part of normal cultural or religious practices. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.
5. The disturbance is not due to the direct physiological effects of a substance or a general medical condition.

DID is the current name for multiple personality disorder (MPD), first used in DSM-IV. The term DID is felt to reflect more accurately the condition of an individual with two or more personality states. This change recognizes that MPD represents the failure to form one core personality rather than to simply create many personalities. DID is developed by the age of 5. Adapted from DSM 5

DSM-5 See Diagnostic and Statistical Manual of Mental Disorders.

dual diagnosis This refers to the co-existence of a mental disorder and substance abuse disorder. The current term for this is co-existing disorders, also called co-morbidity. See also co-existing disorders.

eating disorders A category of mental disorders described in DSM-5. Individuals with these disorders, such as anorexia nervosa and bulimia, show a marked disturbance in eating behavior. Some individuals with DID and PTSD also have an eating disorder.

EMDR See Eye Movement Desensitization and Reprocessing.

empathy The ability to put one’s self into the psychological frame of reference or point of view of another, to feel what another feels.

executive control In the internal system of a person with a dissociative disorder, authority over the body and its behavior by a particular personality state, usually the host.

experiential therapies Therapeutic techniques that utilize metaphors and analogies to help clients understand and change their behaviors, traditionally in a group format. These techniques encourage the client to directly experience feelings and thoughts by participating in activities such as art, group sculpting, outdoor challenge courses, etc. See also expressive therapies.

explicit memory Consciously recalled facts or events (knowing that) which have verbal components. This is the form of memory used, for example, when a person recounts the events of his or her day at work or at school. Also referred to as narrative or declarative memory. See also implicit memory.

expressive therapies Specific therapeutic techniques that facilitate expression of feelings through language or movement. Examples include dance, art, and poetry therapy. Most often used as adjunctive therapy to gain access to feelings or memories, expressive therapies are increasingly used for primary treatment in trauma cases. Since traumatic memories may be stored on sensory motor or visual levels, the use of these therapies may access memories not usually available through talking therapy.

Eye Movement Desensitization and Reprocessing (EMDR) A procedure which produces rapid eye movements in a client while a traumatic memory is recalled and processed. This technique seems to lessen the amount of therapeutic time needed to process and resolve traumatic memories. Developed by Francine Shapiro, this technique requires training and following of specific protocols for appropriate use.

false memory A term developed in the early 1990s by the False Memory Syndrome Foundation to describe memories that are not based on actual events. This term is popular in the media, although the concept of false memory is not based on clinical research or accepted theoretical formulation. The terms false memory, delayed memory, and repressed memory are often used interchangeably in the popular literature but they actually have distinct meanings.

False Memory Syndrome (FMS) “False memory syndrome” is a term coined in the early 1990s by the False Memory Syndrome Foundation (FMSF). The FMSF defines the syndrome as “a condition in which the person’s personality and interpersonal relationships are oriented around a memory that is objectively false but strongly believed in to the detriment of the welfare of the person and others involved in the memory.” Goldstein, Confabulations: Creating False Memories – Destroying Families. This organization was founded by parents of adult children who reported delayed memories of child abuse usually uncovered in psychotherapy. These parents deny the abuse and believe false memories have been implanted by therapists in the minds of their adult children. The term “false memory syndrome” is popular in the media but is not based on clinical research or accepted theoretical formulations. It is not listed as a diagnosis or symptom in the DSM-5, nor is there a known treatment or cure. See also delayed memory and repression.

flashbacks A type of spontaneous abreaction common to victims of acute trauma. Also known as “intrusive recall,” flashbacks have been categorized into four types:

• dreams or nightmares
• dreams from which the dreamer awakens but remains under the influence of the dream content and has difficulty making contact with reality
• conscious flashbacks, in which the person may or may not lose contact with reality and which may be accompanied by multimodal hallucinations
• unconscious flashbacks, in which a person “relives” a traumatic event with no awareness at the time or later of the connection between the flashback and the past trauma.
  Putnam, Diagnosis and Treatment of Multiple Personality Disorder, pp. 236-237.

flight or fight response An automatic response to an experience that is perceived to be a threat to survival. The part of the brain that regulates metabolic and autonomic function and prepares muscles to act — to either flee or fight. This survival mechanism works well when the situation allows for an active response. In repeated traumatic situations, when there is no opportunity to fight or flee, this response may result in a chronic state of physiological arousal which is very stressful to the body. See also autonomic arousal.

flooding The process of becoming overwhelmed by intrusive emotions, sensory experiences, or intense re-living experiences; commonly associated with posttraumatic stress disorder.

FMS See False Memory Syndrome.

fragment Within the personality system of a person who has a dissociative disorder, a fragment is a dissociated part of that person which has limited function and is less distinct or developed than a personality state. Usually a fragment has a consistent emotional and behavioral response to specific situations. For example, a fragment may handle the expression of feelings through drawing. The term “special purpose fragment” refers to a part with an even more narrowly defined function.

Fugue See dissociative fugue.

grounding Reality based awareness in the here and now, a sense of connectedness to yourself and your environment.

hypermnesia This experience of heightened memory is a symptom of PTSD. It is the opposite of amnesia, which is the forgetting of events. Hypermnesia consists of abnormally sharp or vivid recall. For example, a trauma survivor may vividly remember a traumatic event with total recall of all details–sight, sound, feel, smell, and touch. Hypermnesia may be intrusive and may interfere with everyday functioning.

hypervigilance One of the symptoms of PTSD. In this state an individual is overly sensitive to sounds and sights in the environment, scans the environment expecting danger, and feels keyed up and on edge. In addition, a traumatized person may have an exaggerated startle response and problems with memory and concentration.

hypnosis An altered state of consciousness which is subjectively experienced by an individual as different from normal alertness. This may occur spontaneously, as in spontaneous trance, or may be suggested by a therapist or hypnotist. The individual who is hypnotized may experience altered perception or memory. Hypnosis is often used in the treatment of DID (MPD) to facilitate communication between personality states, to overcome amnesiac barriers and to promote healing through managed abreaction. Before using hypnosis in treatment it is recommended that the client be provided with enough information to give his or her informed consent and that this be documented. Hypnosis is also referred to as being in a trance state. The process of dissociation itself may be a form of self-hypnosis.

iatrogenesis When medical treatment or psychotherapy causes an illness or aggravates an existing illness. In psychotherapy, this may occur as a result of the comments, questions, or attitudes of the therapist.

imagery Using your imagination to manage stress responses and feelings.

implicit memory Behavioral knowledge of an experience (knowing how) without conscious recall or verbal components; habit memory. Driving, riding a bicycle, or reading are examples of skills which people implicitly remember how to do without consciously remembering steps involved. This type of memory is almost always irretrievable in words. (Lenore Terr, M.D., personal correspondence, 31 August 1994.) Also called procedural or sensorimotor memory. See also, explicit memory.

informed consent In psychotherapy, informed consent occurs when a client is informed of:

• the diagnosis
• the nature of the treatment being considered
• the risks and benefits of such treatment
• the likely outcome with and without treatment
• alternative approaches to relieve the symptoms

The information must be presented in a form the client can understand and consent must be given without coercion. Often this information is presented in written form which the client signs, thereby giving permission for treatment.

integration The ongoing process of bringing together all dissociated aspects of self, whether they are thoughts, feelings, behavior, or are organized as personality states or fragments. This process begins before the fusion of specific personality states and continues throughout the psychotherapy. There is lack of agreement about the end goal of DID (MPD) treatment. Some therapists and clients consider integration the treatment goal while others do not. This complex decision is best discussed together by therapist and client.

International Society for the Study of Dissociation (ISSTD) a not-for-profit professional association organized to promote research and training in the identification and treatment of Dissociative Identity Disorder and other dissociative states. ISSTD provides professional and public education about DID and other dissociative states and serves as a catalyst for international communication and cooperation among clinicians and investigators working in this field.

International Society for Traumatic Stress Studies, Inc. (ISTSS) A non-profit organization to “promote the advancement of knowledge about the immediate and long-term human consequences of extraordinary events and to promote effective methods of preventing or ameliorating the unwanted consequences of them.”

ISSTD See International Society for the Study of Dissociation.

ISTSS See International Society for Traumatic Stress Studies.

journal writing The process of using structured exercises to write about thoughts, feelings, and stress responses in an effort to increase self-awareness and decrease symptoms.

learned helplessness A term developed by Martin Seligman, pioneering researcher in animal psychology, to describe what occurs when animals or human beings learn that their behavior has no effect on the environment. The impact of this experience leaves an individual apathetic, depressed, and unwilling to try previous or new behavior. This concept is relevant to people with dissociative disorders who may show some degree of learned helplessness due to repeated exposure to traumatic events which they could not change or avoid by their behavior.

losing time Specific to the dissociative disorder field, having no recollection of one’s activities during a given time period (hours, days, years). Unaccounted-for periods of time are generally confusing and frightening to an individual who has DID (MPD) and may allow for the person’s re-victimization.

mental status exam (MSE) The MSE, which is conducted by a mental health professional, is a formal evaluation of a client’s current psychological, emotional, and behavioral functioning. Areas of assessment include: orientation to time, place, and person as well as thought content, cognition, mood, affect, insight, and general intelligence. This evaluation is usually summarized on the five axes of DSM-IV and in a narrative report.

multiple personality disorder (MPD) In DSM-III-R, MPD was classified as a dissociative disorder. The diagnostic criteria were:

• The existence of two or more distinct personalities or personality states within one person with each personality having a distinct and consistent pattern of relating to self and the environment.
• At least two of these personalities or personality states recurrently take full control of the person’s behavior.

In general, individuals with MPD have a background of child abuse or other forms of severe childhood trauma. MPD was renamed Dissociative Identity Disorder (DID) in the 1994 DSM-IV. Dissociative identity disorder (DID) is the current name for this disorder in DSM-5. In addition to the name, more items have been added to the criteria. See also dissociative identity disorder for the current criteria. Adapted from DSM-III- R, p. 272.

numbing A symptom common to individuals with PTSD. It represents an individual’s attempt to compensate for intrusive thoughts, memories, or feelings of the trauma by shutting down and becoming numb to internal or external stimuli. Also called psychic numbing.

other specified dissociative disorder (OSDD)- a diagnosis which was introduced in the DSM-5 psychiatric manual, released in 2013. Along with Unspecified Dissociative Disorder it replaces the diagnosis of Dissociative Disorder Not Otherwise Specified (DDNOS). It is known to be caused by psychological trauma. In common with all Dissociative Disorders, symptoms usually appear after trauma and include embarrassment or confusion about symptoms, and the desire to hide them. According to the DSM-5, "This category applies to presentations in which symptoms characteristic of a dissociative disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the dissociative disorders diagnostic class. The other specified dissociative disorder category is used in situations in which the clinician chooses to specify reason that the presentation does not meet the criteria for any specific dissociative disorder. This is done by recording "other specified dissociative disorder" followed by the specific reason (e.g., "dissociative trance").

personality states In the dissociative disorders field, this refers to an entity that has the following:

• a consistent and ongoing set of response patterns to given stimuli
• a significant confluent history
• a range of emotions available (anger, sadness, joy, and so on)
• a range of intensity of affect for each emotion (for example, anger ranging from neutrality to frustration and irritation to anger and rage).

Also known as ego states, personalities, alters, parts, etc. Braun, Treatment of Multiple Personality Disorder, p. xii.

posttraumatic stress disorder (PTSD) An anxiety disorder based on how an individual responds to a traumatic event. According to DSM-IV, the following criteria must be met:

• A person was exposed to one or more event(s) that involved death or threatened death, actual or threatened serious injury, or threatened sexual violation. In addition, these events were experienced in one or more of the following ways:
  1. The event was experienced by the person.
  2. The event was witnessed by the person as it occurred to someone else.
  3. The person learned about an event where a close relative or friend experienced an actual or threatened violent or accidental death.
  4. The person experienced repeated exposure to distressing details of an event, such as a police officer repeatedly hearing details about child sexual abuse.
• A person experiences at least one of the following intrusive symptoms associated with the traumatic event:
  1. Unexpected or expected reoccurring, involuntary, and intrusive upsetting memories of the traumatic event
  2. Repeated upsetting dreams where the content of the dreams is related to the traumatic event
  3. The experience of some type of dissociation (for example, flashbacks) where the person feels as though the traumatic event is happening again
  4. Strong and persistent distress upon exposure to cues that are either inside or outside of a person's body that are connected to the person's traumatic event
  5. Strong bodily reactions (for example, increased heart rate) upon exposure to a reminder of the traumatic event
• Frequent avoidance of reminders associated with the traumatic event, as demonstrated by one of the following:
  1. Avoidance of thoughts, feelings, or physical sensations that bring up memories of the traumatic event
  2. Avoidance of people, places, conversations, activities, objects, or situations that bring up memories of the traumatic event
• At least three of the following negative changes in thoughts and mood that occurred or worsened following the experience of the traumatic event:
  1. The inability to remember an important aspect of the traumatic event
  2. Persistent and elevated negative evaluations about one's self, others, or the world (for example, "I am unlovable," or "The world is an evil place")
  3. Elevated self-blame or blame of others about the cause or consequence of a traumatic event
  4. A negative emotional state (for example, shame, anger, fear) that is pervasive
  5. Loss of interest in activities that one used to enjoy
  6. Feeling detached from others
  7. The inability to experience positive emotions (for example, happiness, love, joy)
• At least three of the following changes in arousal that started or worsened following the experience of a traumatic event:
  1. Irritability or aggressive behavior
  2. Impulsive or self-destructive behavior
  3. Feeling constantly "on guard" or like danger is lurking around every corner (or hypervigilance)
  4. Heightened startle response
  5. Difficulty concentrating
  6. Problems sleeping
  7. The above symptoms last for more than one month, bring about considerable distress and/or interfere greatly with a number of different areas of a person's life, and the symptoms are not due to a medical condition or some form of substance use. (adapted from the DSM-5)

posttraumatic stress disorder dissociative subtype- a subtype of PTSD introduced in the DSM-5. PTSD dissociative subtype is when PTSD is seen with prominent dissociative symptoms, in particular high levels of depersonalization and derealization.

posttraumatic stress disorder preschool subtype- a subtype of PTSD in the DSM-5 for children younger than six years old

pseudoseizures- “Pseudoseizures are sudden changes in a person’s behavior and/or mental state that resemble epileptic seizures but which are not caused by a physical disorder of the brain. They may look like any type of epileptic seizure: staring unresponsively, generalized stiffening and rhythmic jerking, movements of only a few body parts, or alterations of awareness. During these spells, brain cells are firing normally and the brain wave tracing does not show the changes which are characteristic of epileptic seizures. ”Several research studies have found that many pseudoseizures are really dissociative trance episodes, dissociative switching of ego states, or dissociative states in which unconscious emotional distress is expressed. Many studies have noted high rates of sexual and physical abuse among pseudoseizure patients and pointed to abuse as one cause of pseudoseizures. Pseudoseizures have been reported in dissociative identity disorder patients and may be the symptom that leads to seeking treatment. There are non-dissociative causes for pseudoseizures, so persons who suffer from them should not be assumed to have a dissociative disorder.” (Elizabeth S. Bowman, M.D., personal correspondence, 22 August 1994.)

psychic numbing see numbing

psychodrama A group psychotherapy technique. Under the direction of a therapist, individuals re-enact life situations or feelings in order to gain insight or learn new ways of coping. It is one of the adjunctive therapies used in treating trauma disorders.

psychodynamic A theoretical orientation that recognizes the role of the unconscious in determining behavior. It also considers the interplay of the unconscious with the current situation, cognitive ability, and life experience.

PTSD See posttraumatic stress disorder.

Rational Emotive Therapy (RET) A cognitive psychotherapy approach developed by Albert Ellis which focuses on the client’s thoughts and beliefs. The goals of therapy are to identify unrealistic and illogical thoughts (such as “I must always be happy”), question these thoughts or beliefs, and replace them with more reasonable and constructive views. In this school of thought, behavior is understood to be based on beliefs rather than external conditions. This form of therapy is used to help trauma survivors to identify mistaken beliefs brought on by the traumatic experiences.

reality check A technique that helps you to become aware of the true state of affairs in a particular experience.

regression The return to earlier or younger behavior and thinking. Trauma often overwhelms everyday defenses and brings about behavioral regression. Child personality states are an example of trauma-based regression. In “age regression,” a person experiences him or herself at a specific earlier age. The person does not always return to the age of a child, however; age regression may take a client back a few years earlier in adult life.

repetition compulsion Originally defined by Freud as the repetitive re-enactment of earlier emotional experiences, this type of behavior may be seen in the lives of trauma survivors. For example, a survivor of traumatic abuse may put herself in a situation where there is a risk of additional abuse in an attempt to psychologically master the previous traumatic experiences.

repression An unconscious defense mechanism which occurs when unacceptable ideas, images, or fantasies are kept out of awareness. This is done without an individual consciously knowing that it has taken place. Repression is one psychological mechanism that may account for amnesia of traumatic events.

re-traumatizing Re-enacting or reinforcing a traumatic experience or belief.

revictimization Describes the experience of a survivor being victimized or traumatized after the original trauma. Examples of revictimization include psychological abuse that may occur in a survivor’s interactions with authorities such as the courts, law enforcement personnel, or therapists. This process is important to address in therapy. In some cases it seems that a survivor may unconsciously allow or encourage this subsequent trauma to occur.

revivification The vivid remembering of past experiences. When remembering traumatic events the client may see, hear, taste, smell, and feel as though the event is happening in the present. This is common during an abreaction or flashback of previous trauma.

ritual abuse While not necessarily satanic, ritual abuse generally involves cult-like or religious rituals and mind control in addition to sexual, physical and/or psychological abuse. “…repeated abuse over an extended period of time. The physical abuse is severe, sometimes including torture and killing. The sexual abuse is usually painful, humiliating, intended as a means of gaining dominance over the victim. The psychological abuse is devastating and involves the use of ritual indoctrination. It includes mind control techniques which convey to the victim a profound terror of the cult members…most victims are in a state of terror, mind control and dissociation.” Report of the Ritual Abuse Task Force, Los Angeles County Commission for Women, 1991, p. 1.

sadistic abuse Describes “extreme adverse experiences which include sadistic sexual and physical abuse, acts of torture, over-control, and terrorization, induction into violence, ritual involvements, and malevolent emotional abuse. Sadism was defined by Freud’s mentor, Krafft-Ebing (1894-1965), in the nineteenth century, as follows: ‘The experience of sexual or pleasurable sensations… produced by acts of cruelty, as bodily punishment inflicted on one’s own body or witnessed in others, be they animals or human beings. It may also consist of innate desire to humiliate, hurt, wound, or even destroy others. . . .'” See also ritual abuse. Goodwin, “Sadistic Abuse: Definition, Recognition, and Treatment,” Dissociation, 6:3, pp. 181-182.

sand tray therapy A therapeutic technique, similar to play therapy, in which a tray of sand with figures and toys is provided for a client to create a scene or story to be discussed with a therapist. The “world” that a client creates may directly or symbolically represent previous life experiences, conflicts, feelings, or fears. This technique, when used to process traumatic events, allows a client emotional distance and the opportunity to process the feelings, thoughts, and beliefs that may accompany a traumatic experience.

screen memory A partially true memory that an individual subconsciously creates because the actual memory is intolerable. For example, a client may report abuse by a distant uncle when actually the abuser was the father. This disguised presentation allows the client time to adjust to aspects of the abuse before accepting the total reality of the situation.

secondary PTSD See vicarious traumatization.

self-harm The action of harming oneself without the intent to commit suicide. The many forms of self-harm include cutting, burning, eating disorders, etc. For trauma survivors, self-harm can function as tension reduction, punishment, trauma re-enactment, or rage expression. Also called self-inflicted violence or self-injury. See also self-mutilation.

self-inflicted violence See self-harm.

self-injury See self-harm.

self-hypnosis “Spontaneous or purposeful hypnotic trance states produced within his or her own psyche. These states may include any or all of the full range of hypnotic phenomena such as sensory alterations, anesthesia, time distortion, relaxation, age regression, and alterations in physiological functioning.” ISSD Practice Guidelines, Glossary, 1994.

self-mutilation A form of self-harm motivated specifically by the desire to scar or disfigure one’s body; “Defined by Walsh and Rosen (1988) as `deliberate, non- life-threatening, self-effected bodily harm or disfigurement of a socially unacceptable nature’ (p.10), self-mutilation most typically involves repetitious cutting or carving of the body or limbs, burning of the skin” Briere, Child Abuse Trauma: Theory and Treatment of the Lasting Effects, p. 66. See also self-harm.

self-regulation The process of consciously managing different internal states by 1. experiencing them as they come up, 2. expressing what you are experiencing, 3. consciously postponing dealing with traumatic material or overwhelming aspects of feelings, and 4. retrieving part of what you have contained when you are better able to manage it.

sleep-wake disorders A category in DSM-5 which includes various disorders of sleep, such as insomnia disorder and nightmare disorder. Sleep disturbances are common in people with PTSD.

somatic memory “A physical sensation or change in physical functioning without the presence of organic illness, that represents a dissociated aspect of a traumatic or abusive experience.” ISSD Practice Guidelines, Glossary, 1994. See also body memory.

somatic symptom disorder a condition in the DSM-5 in which a person has excessive focus on physical symptoms that results in major distress and/or problems functioning. The physical symptoms may or may not be associated with a diagnosed medical condition, but the person is experiencing symptoms and believes they are sick.

spontaneous trance See self- hypnosis.

startle reaction This symptom of both PTSD and generalized anxiety disorder occurs when an individual reacts strongly to new and unexpected stimuli in the environment. An example of a startle reaction would be jumping out of a chair when a door is slammed. Also called startle response.

state dependent memory A similar concept to state dependent learning. Based on research and clinical experience, it appears that information and events may be best remembered in the same emotional or physiological state in which it was learned. For trauma survivors an event that produced extreme fear may not be recalled during normal everyday conditions, including psychotherapy. Recall of this past event may only be available to consciousness at another time of extreme fear. This is one reason why a current traumatic event, with all the feelings and high arousal state, may trigger memory of forgotten earlier trauma. Also referred to as context dependent memory.

switching The process of changing from one already existing personality state or fragment to another personality state or fragment. Switching may be set off by outside stimuli such as an environmental trigger, or by internal stimuli, such as feelings or memories. Switching may be observable, such as changes in posture or facial expression, as well as changes in voice tone or speech patterns. Switching may also be observed by changes in mood, regressed behavior, and variable cognitive functioning.

system A descriptive term for all the aspects or parts of the mind in an individual with DID (MPD). This includes personality states, memories, feelings, ego states, entities, and any other way of describing dissociated aspects of an individual. Understanding the parts as a system rather than as separate personality states provides an important frame of reference for treatment. Also called internal system or personality system.

trance Used interchangeably with hypnosis. A person in a trance or in an altered state of focused attention is in a hypnotic state.

trance logic The ability of a hypnotized person to tolerate the existence of inconsistent perceptions or ideas. “The inconsistent perceptions are not kept isolated but appear in juxtaposition . . . The essence of this phenomenon seems to be the suspension of critical thinking.” Udolf, Handbook of Hypnosis for Professionals, pp.108-108.

transference “The unconscious assignment to others of feelings and attitudes that were originally associated with important figures in one’s early life.” The psychodynamically oriented clinician uses this to help the client understand the origins of emotional problems. The transference phenomena is complicated in DID because each alter may have its own transference relationship with the therapist. American Psychiatric Glossary, p. 211. See also traumatic transference.

trauma A medical term for any sudden injury or damage to an organism. Psychological trauma is an event that is outside the range of usual human experience and which is so seriously distressing as to overwhelm the mind’s defenses and cause lasting emotional harm. Traumatic events include natural disasters, accidents, or human actions, such as child abuse, rape, torture, etc., which cause the victim to be terrified, helpless, and under extreme physical stress. Most individuals with DID have been victims of repeated trauma and generally also exhibit symptoms of post traumatic stress disorder.

traumatic transference The unconscious assignment to a therapist of feelings and attitudes associated with an abuser during earlier traumatic events. For example, recalling being beaten in childhood, a client may ask the therapist not to hit or hurt her, as if she were talking to the abuser. Working through the traumatic transference may be an important aspect for understanding early childhood trauma.

trigger An event, object, person, etc. that sets a series of thoughts in motion or reminds a person of some aspect of his or her traumatic past. The person may be unaware of what is “triggering” the memory (i.e., loud noises, a particular color, piece of music, odor, etc.). Learning not to overreact to triggers is a therapeutic task in the treatment of dissociative disorders.

Type I and Type II Trauma Terms developed by Lenore Terr to describe different types of trauma. A single traumatic event such as a fire or single rape episode is considered to be Type I Trauma. Repeated, prolonged trauma, such as extensive child abuse, is considered to be Type II Trauma. According to Terr’s formulation of this concept, these two types of trauma result in different coping styles. Individuals with Type I Trauma receive support from family and friends and usually remember the trauma event. Individuals with Type II Trauma are more likely to have severe PTSD symptoms, such as psychic numbing, and dissociation. Type II Trauma is often kept a secret and support from family and friends may be absent. Terr, Unchained Memories, p. 11, 30.

unification “An overall, general term that encompasses both fusion and integration.” Kluft, “Clinical Approaches to the Integration of Personalities,” in Clinical Perspectives on Multiple Personality Disorder, p.109.

unspecified dissociative disorder A diagnosis which was introduced in the DSM-5 psychiatric manual, released in 2013. Along with Other Specified Dissociative Disorder it is partial replacement for the previous diagnosis of Dissociative Disorder Not Otherwise Specified (DDNOS). According to the American Psychiatric Association's DSM-5: "This category applies to presentations in which symptoms characteristic of a dissociative disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the dissociative disorders diagnostic class. The unspecified dissociative disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific dissociative disorder, and includes presentations for which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings)."

V-codes These are categories of problems that may need therapeutic intervention but are not considered psychological disorders or mental illness. Conflict between parents and teenagers would be an example of this. Adapted from DSM-5

vicarious traumatization Describes the experiences of mental health providers who become overly empathic after listening to accounts of abuse or violence by trauma survivors. Symptoms of vicarious traumatization are similar to those experienced by individuals with PTSD, and include psychic numbing, hypervigilance, difficulty sleeping, and intrusive thoughts of the trauma, which were reported by the client. Also called secondary PTSD or compassion fatigue. Kluft and Fine, Clinical Perspectives, p.164.